Cost-effectiveness of different diagnostic alternatives for rotator cuff tear
Keywords:
rotator cuff, health care costs, ultrasound, magnetic resonance imaging, arthroscopy, arthrography.Abstract
AIM: To determine the cost-effectiveness ratio of physical examination (PE), ultrasound, imaging magnetic resonance (IMR), magnetic resonance arthrography (MRA) and arthroscopy for diagnosis of rotator cuff tear.Material and methods:
A cost-effectiveness study using a health sector perspective was designed. The costs were calculated with national tariffs+30% of cumulative inflation until 2012. The effectiveness data (number of diagnosed cases) were extracted from a systematic review.
Results:
The PE was ineffective. The ultrasound showed the lower average cost-effectiveness ratio (ACER) to diagnose total rupture in general population ($312.178,9/case) and people up to 50 years (range: $118.628/case-$1.186.280/case). However, IMR is more efficient than ultrasound to diagnose a partial rupture ($2.000.830/case). MRA was the most efficient alternative to diagnose total rupture in people in the 40s. The model using decision tree displayed that ultrasound has more efficiency (224.334,3/case) in patients with shoulder pain. The probabilistic sensitivity analysis using MonteCarlo technique showed a ACER of ultrasound, IMR, MRA and arthroscopy of $660.724,1/case (95%CI: $591.996,5/case - $746.633,6/case); $3.218.465,8/case (95%CI: $2.981.328,2/case -$3.492.086/case), $4.136.908,3/ case (95%CI:$3.880.981,6/case-$4.424.825,8/case) and $6.231.089,2/case (95%CI: 5.981.572,6/case-$6.502.302,7 /case) respectively. The incremental costeffectiveness ratio was $7.822.400/case (95%CI: $7.759.991,8/case-$7.884.809,8/case), $8.422.973,6/ case (95%CI: $8.379.248,8/case-$8.466.698,3/case) and $11.316.956,8/case (95CI: $11.250.821,4/case- $11.383.092,3/case) respectively.
Conclusion:
The ultrasound represents the most costeffective alternative to diagnose rotator cuff tear in general population and older than 50 years.
Author Biography
César Augusto Guevara Cuellar, Universidad Icesi-PROESA Fundación Valle del Lili
Médico especialista en Medicina Familiar. Fundación Valle del Lili Cali,Colombia.
Director de programa de Medicina, Universidad Icesi.
Especialista en Gerencia Social, Universidad Javeriana.
Maestría en Economía de la Salud, Universidad Pompeu Fabra.
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joint. Eur J Radiol 2000;35:126-135. Costo-efectividad de diferentes alternativas diagnósticas de ruptura del manguito rotador 145
14. Shahabpour M, Kichouh M, Laridon E, Gielen JL, De Mey J. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol 2008;65:194-200.
15. Oh CH, Schweitzer ME, Spettell CM. Internal derangements of the shoulder: decision tree and cost-effectiveness analysis of conventional arthrography, conventional MRI, and MR arthrography. Skeletal Radiol 1999;28:670-678.
16. Godefroy D, Sarazin L, Rousselin B, Dupont AM, Drapé J, Chevrot A. Shoulder imaging: what is the best modality? J
Radiol 2001;82:317-332.
17. Sonnabend DH, Hughes JS, Giuffre BM, Farrell R. The clinical role of shoulder ultrasound. Aust N Z J Surg 1997;67:630-633.
18. Bachmann GF, Melzer C, Heinrichs CM, Möhring B, Rominger MB. Diagnosis of rotator cuff lesions: comparison
of US and MRI on 38 joint specimens. Eur Radiol 1997;7:192-197.
19. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd et al. Physical examination tests of the
shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med 2008;42:80-92.
20. Riddle D. Individual tests from the history and physical examination are inaccurate in diagnosing rotator cuff tears. Aust J Physiother 2001;47:297-298.
21. Hughes PC, Taylor NF, Green RA. Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Aust J Physiother 2008;54:159-170.
22. Virta L, Joranger P, Brox JI, Eriksson R. Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC Musculoskelet Disord 2012;10(13):17.
2. Hill CL, Gill TK, Shanahan EM, Taylor AW. Prevalence and correlates of shoulder pain and stiffness in a populationbased study: the North West Adelaide Health Study. Int J Rheum Dis 2010;13:215-222.
3. Pribicevic M, Pollard H, Bonello R. An epidemiologic sur vey of shoulder pain in chiropractic practice in Australia. J Manipulative Physiol Ther 2009;32:107-117.
4. Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E. Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a populationbased study. BMC Musculoskelet Disord 2010;11:165.
5. Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primar y care. Primar y Care Rheumatology Society Shoulder Study Group. BMJ 1996;313:601-602.
6. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ 2005;331:1124- 1128.
7. van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract 1996;46:519-523.
8. Yamamoto A , Ta k agishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010;19:116-120.
9. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological
features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 2006;88:1699-1704.
10. Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Osawa T. Factors involved in the presence of symptoms associated with rotator cuff tears: a comparison of asymptomatic and symptomatic rotator cuff tears in the general population. J Shoulder Elbow Surg 2011;20:1133-1137.
11. Dinnes J, Loveman E, McIntyre L, Waugh the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess 2003;7:1-166.
12. Zanetti M, Hodler J. Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound. Eur J Radiol 2000;35:119-125.
13. Lee SU, Lang P. MR and MR arthrography to identify degenerative and posttraumatic diseases in the shoulder
joint. Eur J Radiol 2000;35:126-135. Costo-efectividad de diferentes alternativas diagnósticas de ruptura del manguito rotador 145
14. Shahabpour M, Kichouh M, Laridon E, Gielen JL, De Mey J. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol 2008;65:194-200.
15. Oh CH, Schweitzer ME, Spettell CM. Internal derangements of the shoulder: decision tree and cost-effectiveness analysis of conventional arthrography, conventional MRI, and MR arthrography. Skeletal Radiol 1999;28:670-678.
16. Godefroy D, Sarazin L, Rousselin B, Dupont AM, Drapé J, Chevrot A. Shoulder imaging: what is the best modality? J
Radiol 2001;82:317-332.
17. Sonnabend DH, Hughes JS, Giuffre BM, Farrell R. The clinical role of shoulder ultrasound. Aust N Z J Surg 1997;67:630-633.
18. Bachmann GF, Melzer C, Heinrichs CM, Möhring B, Rominger MB. Diagnosis of rotator cuff lesions: comparison
of US and MRI on 38 joint specimens. Eur Radiol 1997;7:192-197.
19. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd et al. Physical examination tests of the
shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med 2008;42:80-92.
20. Riddle D. Individual tests from the history and physical examination are inaccurate in diagnosing rotator cuff tears. Aust J Physiother 2001;47:297-298.
21. Hughes PC, Taylor NF, Green RA. Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Aust J Physiother 2008;54:159-170.
22. Virta L, Joranger P, Brox JI, Eriksson R. Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC Musculoskelet Disord 2012;10(13):17.
How to Cite
1.
Guevara Cuellar CA. Cost-effectiveness of different diagnostic alternatives for rotator cuff tear. Rev. Colomb. Med. Fis. Rehabil. [Internet]. 2013 Dec. 15 [cited 2024 May 18];23(2):135-4. Available from: https://revistacmfr.org/index.php/rcmfr/article/view/76
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Published
2013-12-15
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